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Montaguti E, Petrachi B, Youssef A, Pilu G. Pearl in a shell: a peculiar case of fetal ovarian cyst. Ultrasound Obstet Gynecol 2024. [PMID: 38528738 DOI: 10.1002/uog.27645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/05/2024] [Accepted: 03/09/2024] [Indexed: 03/27/2024]
Affiliation(s)
- E Montaguti
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - B Petrachi
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Youssef
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Ashktorab H, Oskrochi G, Challa SR, Chirumamilla LG, Saroya S, Dusmatova S, Shayegh N, Nair V, Senthilvelan K, Byer D, Morrison N, Grossi B, Barclay A, Smith T, Watson K, Rashid M, Rashid R, Deverapalli M, Latella G, Carethers JM, Youssef A, Brim H. Age, Gender, and Liver Enzyme Impact Hospital Stay in COVID-19 Minority Patient with Cancer in the USA: Does Race Matters in the Pandemic? Ann Clin Med Case Rep 2024; 13:7. [PMID: 38633403 PMCID: PMC11022387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Patients with cancer are known to have a poor prognosis when infected with SARS-CoV-2 infection. We aimed in this study to assess health outcomes in COVID-19 patients with different cancers in comparison to non-cancer COVID-19 patients from different centers in the United States (US). We evaluated medical records of 1,943 COVID-19 Cancer patients from 3 hospitals admitted between December 2019 to October 2021 and compared them with non-cancer COVID-19 patients. Among 1,943 hospitalized COVID-19 patients, 18.7% (n=364) have an active or previous history of cancer. Among these 364 cancer patients, 222 were African Americans (61.7%) and 121 were Caucasians (33.2%). Cancer patients had significantly longer hospitalization compared to controls (8.24 vs 6.7 days). Overall, Lung cancer is associated with high mortality. Patients with a previous history of cancer were more prone to death (p=0.04) than active cancer patients. In univariate and multivariate analyses, predictors of death among cancer patients were male sex, older age, presence of dyspnea, elevated troponin, elevated AST (0.001) and ALT (0.05), low albumin (p=0.04) and mechanical ventilation (p=0.001). Patients with a previous history of cancer were more prone to death when compared to active cancer COVID-19 patients. Early recognition of cancer COVID-19 patients' death-associated risk factors can help determine appropriate treatment and management plans for better prognosis and outcome.
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Affiliation(s)
- H Ashktorab
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - G Oskrochi
- College of Engineering and Technology, American University of the Middle East, Kuwait
| | - S R Challa
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - L G Chirumamilla
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - S Saroya
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - S Dusmatova
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - N Shayegh
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - V Nair
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - K Senthilvelan
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - D Byer
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - N Morrison
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - B Grossi
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - A Barclay
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - T Smith
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - K Watson
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - M Rashid
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - R Rashid
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - M Deverapalli
- Department of Medicine, GI Division, Cancer Center, Howard University Hospital, Washington DC, USA
| | - G Latella
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - J M Carethers
- Division of Gastroenterology & Hepatology, Department of Medicine and Moores Cancer Center, UC San Diego, USA
| | - A Youssef
- Division of Gastroenterology and Hepatology, Department of Internal Medicine; Department of Human Genetics and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - H Brim
- Department of Pathology and Cancer Center, Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington DC, USA
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Youssef A, Del Magno A, Nedu B, Dapoto F, Brunelli E. Feasibility and reproducibility of new technique for measurement of transverse diameter of levator ani muscle hiatus using two-dimensional transperineal ultrasound in nulliparous women at term. Ultrasound Obstet Gynecol 2024. [PMID: 38308852 DOI: 10.1002/uog.27595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/17/2023] [Accepted: 01/15/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES The aim of the present study was twofold; firstly to develop and describe the technique for measurement of the transverse diameter of the levator ani muscle hiatus (TD) in the coronal view using 2D transperineal ultrasound (TPUS) in nulliparous women at term of pregnancy. Secondly, we aimed to assess the feasibility and reproducibility of 2D TPUS assessment of TD, in addition to the inter-method agreement between 2D TPUS and the 3D measurement of TD on the axial plane, the latter considered as the gold standard in nulliparous women at term of pregnancy. METHODS For the aim of the study, we recruited a group of nulliparous women at term of pregnancy before the onset of labor. The study was conducted in two phases: phase 1 involved developing and describing the 2D TPUS technique for measuring TD, while phase 2 focused on assessing the technique's feasibility, reproducibility, and inter-method agreement. In phase 1, we enrolled 30 women. Each woman underwent the acquisition of a 3D TPUS volume, which was analyzed using the multiplanar mode to identify the appearance of the lateral borders of the levator ani muscle at the level of the plane of minimal hiatal dimensions in the coronal plane. These borders were used as landmarks for TD measurement. Additionally, we measured the distance between the line indicating TD and the center of the urethra in the axial view. Phase 2 involved recruiting 100 women. Each woman underwent the acquisition of three 2D TPUS clips in the coronal plane, each encompassing a sweep of the entire levator hiatus, and a 3D volume, all obtained during rest. On the 2D clips, TD was measured twice by one operator and once by another operator. TD was measured once in the 3D volume in the axial plane, considered the gold standard. Each operator was blinded to all other measurements during their assessments. We analyzed intraobserver, interobserver, and intermethod (2D vs. 3D) reproducibility. Bland-Altman analysis was conducted, and Levene's W0 and Student t-tests were performed to explore clinical factors that might contribute to systematic differences. RESULTS In phase 1, we successfully identified the landmarks denoting the lateral borders of TD in the coronal view. These appeared as two symmetrical hypoechoic indentations located at the inner border of the hyperechoic structure of the levator ani muscle, at the point of maximum distance between the two sides of the levator ani muscle. Additionally, the distance between the urethra and the plane where TD was measured using 3D TPUS in the axial plane had a median of 4 mm and varied from 0 to 9 mm. This enabled us to describe the method for assessing TD in the coronal plane through the use of 2D TPUS. In phase 2, TD was successfully measured in all 2D and 3D acquisitions from the entire group of 100 women. The analyses for intraobserver, interobserver reproducibility, and intermethod comparison (2D vs. 3D) revealed almost perfect agreement in TD measurements using 2D TPUS, with Intraclass Correlation Coefficients (ICCs) of 0.95 (95% CI, 0.92 to 0.96), 0.87 (95% CI, 0.78 to 0.92), and 0.85 (95% CI, 0.78 to 0.90), respectively. The average differences between measurements were 0.1 mm for intraobserver, 1.0 mm for interobserver, and 0.2 mm for intermethod repeatability. No systematic differences were observed in any of the measurement sets, except in the inter-operator analysis, although the difference was clinically insignificant (38.2 vs. 37.1 mm, P= 0.01). None of the examined clinical factors (maternal body mass index and maternal age) exhibited a statistically significant impact on intraobserver, interobserver, or intermethod reliability. CONCLUSIONS Utilizing our described technique to measure the transverse diameter of the levator hiatus in the coronal view using 2D TPUS is not only feasible but also highly reproducible and accurate in nulliparous women at term of pregnancy. Moreover, it yields measurements that are comparable to those obtained in the reconstructed axial plane generated by 3D TPUS. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- A Youssef
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Del Magno
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - B Nedu
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - F Dapoto
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - E Brunelli
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Elbahoty M, Elnaggar S, Soror N, Elkeraie A, Youssef A. Co-occurrence of Idiopathic Hypereosinophilic Syndrome in End-Stage Renal Disease Patients Undergoing Maintenance Hemodialysis. Cureus 2024; 16:e53758. [PMID: 38465088 PMCID: PMC10921820 DOI: 10.7759/cureus.53758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Hypereosinophilic syndrome (HES) is defined as the presence of (1) peripheral blood eosinophilia >1.5 x 109/L for at least one month, (2) evidence of eosinophil-mediated organ damage and/or dysfunction, and (3) exclusion of other potential causes of eosinophilia. In hemodialysis patients, HES has been associated with manifestations because of low blood pressure or gastrointestinal symptoms that result in dialysis intolerance. Very few cases of HES co-occurrence in dialysis patients have been reported in the literature, and their clinical characteristics are not fully understood. Here, we report two end-stage renal disease patients diagnosed with idiopathic HES while undergoing maintenance hemodialysis. The first patient presented with unexplained persistent pruritus and intradialytic hypotension, which started 10 minutes after the dialysis session initiation. Hematologic studies revealed hypereosinophilia which remarkably improved on steroid therapy. The second patient was accidentally discovered with asymptomatic persistent hypereosinophilia. His blood counts improved initially on interferon treatment before achieving full remission on steroid therapy. Neither of the two patients reported any history of allergy or atopic manifestations. Our case report sheds light on the possible occurrence of HES in hemodialysis patients which may be confused with other dialysis-related complications. Although steroids remain the mainstay of treatment, the optimal dose and duration of treatment remain unknown.
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Affiliation(s)
- Mohamed Elbahoty
- Department of Pathology, University of Alabama at Birmingham, Birmingham, USA
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Sherine Elnaggar
- Nephrology and Hemodialysis Unit, Alexandria University Hospitals, Alexandria, EGY
| | - Nooran Soror
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Ahmed Elkeraie
- Department of Internal Medicine, Nephrology and Hemodialysis Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Ayman Youssef
- Anesthesiology and Critical Care, Duke University Medical Center, Durham, USA
- Department of Internal Medicine, Hematology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY
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Youssef A, Nedu B, Dapoto F, Brunelli E. Time to focus on the role of the pelvic floor in vaginal delivery. Ultrasound Obstet Gynecol 2024; 63:125-126. [PMID: 38165999 DOI: 10.1002/uog.27556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/11/2023] [Indexed: 01/04/2024]
Abstract
Linked article: This Correspondence comments on Preuss et al. Click here to view the article.
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Affiliation(s)
- A Youssef
- Obstetric and Prenatal Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - B Nedu
- Obstetric and Prenatal Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - F Dapoto
- Obstetric and Prenatal Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - E Brunelli
- Obstetric and Prenatal Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy
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Youssef A, Ulloa L. Ethical and Legal Debates on Vaccine Infodemics. Cureus 2024; 16:e52566. [PMID: 38371094 PMCID: PMC10874613 DOI: 10.7759/cureus.52566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Over the course of three and a half years, the global toll of coronavirus disease 2019 (COVID-19) has claimed the lives of millions of individuals. Scientific breakthroughs, exemplified by mRNA vaccines, have emerged as crucial tools in saving numerous lives and fortifying our defenses against future pandemics. However, the battle against the virus has been complicated by the dissemination of misleading political and ethical information, resulting in avoidable fatalities. Recognizing this phenomenon, the term 'infodemics' has been coined to denote the proliferation of false or misleading information that hinders effective social responses. Given the historical prevalence of infodemics surrounding vaccinations, this discussion delves into the ongoing ethical and legal deliberations concerning vaccination mandates, an indispensable health intervention in the face of pandemics. Governments bear the responsibility of safeguarding their citizens, acknowledging the social requirements imposed by the collective well-being. The protection of both citizens and healthcare workers becomes paramount, considering the potential risks of infection and mortality associated with individuals refusing vaccination. Historically, governments have played a pivotal role in eradicating pandemics through the implementation of vaccine mandates. However, the contemporary landscape is marked by the infusion of political and misleading misinformation, presenting new challenges. Governments are now confronted with an ethical duty to ensure that citizens possess the necessary information to make informed decisions and safeguard their well-being. While grappling with the realization that extraordinary circumstances demand extraordinary responses, the lessons from past pandemics underscore the imperative of prioritizing public health, especially in the context of the high numbers of casualties worldwide. This discourse explores the ethical and legal dimensions surrounding vaccine mandates, with particular emphasis on their relevance to healthcare workers.
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Affiliation(s)
- Ayman Youssef
- Anesthesiology and Perioperative Medicine, Duke University Medical Center, Durham, USA
| | - Luis Ulloa
- Anesthesiology and Perioperative Medicine, Duke University Medical Center, Durham, USA
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Mutsaers A, Tan VS, Youssef A, Nguyen T, Suchit A, Boldt G, Palma DA, Zaric G, Qu M, Louie AV. All that Glitters is Not Gold: Examining Cost Effectiveness Analyses in Radiation Oncology. Int J Radiat Oncol Biol Phys 2023; 117:e602. [PMID: 37785817 DOI: 10.1016/j.ijrobp.2023.06.1966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Cost effectiveness analyses (CEA) provide data for health policy decisions in resource constrained environments. These are important in Radiation Oncology as infrastructure and delivery costs increase and indications expand. The purpose of this study was to systematically review methodologic quality and trends in CEAs involving radiotherapy (RT). MATERIALS/METHODS A systematic review was performed on cost effectiveness/utility studies involving RT, querying PubMed and Embase from inception to September 2020. Non-English, reviews, abstracts and cost-only studies were excluded. Independent reviewers screened and abstracted study demographics, economic parameters and methodological details. RESULTS After screening 1652 abstracts, 214 met criteria. The first publication was in 1995, and more than half (n = 113, 53%) were published after 2014. Author institutions were from North America (n = 128, 60%), Europe (n = 49, 23%) and Asia (n = 30, 14%) with most reporting in US$ (n = 143, 67%). A majority utilized a decision model (n = 164, 77%), healthcare payer perspective (n = 171, 80%) and a finite time horizon (n = 108, 50%). Publications spanned 96 unique journals, most commonly International Journal of Radiation and Oncological Biology and Physics (n = 35, 16%). Treatment intent was curative in 171 studies. Disease sites included breast (n = 34, 16%), genitourinary (n = 31, 14%), and gastrointestinal (n = 31, 14%). RT was mostly used as primary treatment (n = 144, 67%), followed by adjuvant (n = 70, 33%) and neoadjuvant (n = 10, 5%). Emerging topics included stereotactic RT (n = 45, 21%), immunotherapy (n = 6, 3%), oligometastasis (n = 4, 2%), and heavy particles (n = 23, 11%). RT was compared to other RT (n = 136, 64%), surgery (n = 43, 20%), drugs (n = 14, 7%) and observation (n = 31, 17%). Incomplete reporting was common. Missing elements included analysis perspective (n = 13, 6%), time horizon (n = 38, 18%), discounting of utilities (n = 71, 33%) or costs (n = 54, 25%), and willingness-to-pay threshold (n = 59, 28%). Furthermore, 27 studies did not perform sensitivity analyses, 36 did not evaluate incremental cost-effectiveness ratio and only 60 explicitly utilized recognized reporting guidelines. Conflict of interest statements were found in 63%, with sponsor statements in 59%; 25% were industry sponsors. Outcome parameters were obtained from primary (author institution/trial data) sources in 33%, including randomized trials (RCTs) (n = 20, 9%), retrospective data (n = 20, 9%) and population data (n = 9, 4%). The remainder utilized secondary sources including RCTs (n = 71, 33%), retrospective data (n = 35, 16%) or meta-analyses (n = 11, 5%). Outcomes included quality adjusted life years (n = 158, 74%), life-years (n = 30, 14%) or toxicity (n = 26,12%). 31% utilized author generated utilities; of literature derived only 49% were matched to disease and clinical context. CONCLUSION While CEAs are increasingly common in RT, reporting and methodologic rigor must improve. Greater use of published guidelines will improve data quality for decision makers.
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Affiliation(s)
- A Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - V S Tan
- Division of Radiation Oncology, Western University, London Health Sciences Centre, London, ON, Canada
| | - A Youssef
- Durham Regional Cancer Centre, Oshawa, ON, Canada
| | - T Nguyen
- Division of Radiation Oncology, Western University, London Health Sciences Centre, London, ON, Canada
| | - A Suchit
- Western University, London, ON, Canada
| | - G Boldt
- Department of Radiation Oncology, Western University, London, ON, Canada
| | - D A Palma
- Division of Radiation Oncology, Western University, London Health Sciences Centre, London, ON, Canada
| | - G Zaric
- Ivey Business School, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - M Qu
- Division of Radiation Oncology, Western University, London Health Sciences Centre, London, ON, Canada
| | - A V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Sajid MZ, Hamid MF, Youssef A, Yasmin J, Perumal G, Qureshi I, Naqi SM, Abbas Q. DR-NASNet: Automated System to Detect and Classify Diabetic Retinopathy Severity Using Improved Pretrained NASNet Model. Diagnostics (Basel) 2023; 13:2645. [PMID: 37627904 PMCID: PMC10453689 DOI: 10.3390/diagnostics13162645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Diabetes is a widely spread disease that significantly affects people's lives. The leading cause is uncontrolled levels of blood glucose, which develop eye defects over time, including Diabetic Retinopathy (DR), which results in severe visual loss. The primary factor causing blindness is considered to be DR in diabetic patients. DR treatment tries to control the disease's severity, as it is irreversible. The primary goal of this effort is to create a reliable method for automatically detecting the severity of DR. This paper proposes a new automated system (DR-NASNet) to detect and classify DR severity using an improved pretrained NASNet Model. To develop the DR-NASNet system, we first utilized a preprocessing technique that takes advantage of Ben Graham and CLAHE to lessen noise, emphasize lesions, and ultimately improve DR classification performance. Taking into account the imbalance between classes in the dataset, data augmentation procedures were conducted to control overfitting. Next, we have integrated dense blocks into the NASNet architecture to improve the effectiveness of classification results for five severity levels of DR. In practice, the DR-NASNet model achieves state-of-the-art results with a smaller model size and lower complexity. To test the performance of the DR-NASNet system, a combination of various datasets is used in this paper. To learn effective features from DR images, we used a pretrained model on the dataset. The last step is to put the image into one of five categories: No DR, Mild, Moderate, Proliferate, or Severe. To carry this out, the classifier layer of a linear SVM with a linear activation function must be added. The DR-NASNet system was tested using six different experiments. The system achieves 96.05% accuracy with the challenging DR dataset. The results and comparisons demonstrate that the DR-NASNet system improves a model's performance and learning ability. As a result, the DR-NASNet system provides assistance to ophthalmologists by describing an effective system for classifying early-stage levels of DR.
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Affiliation(s)
- Muhammad Zaheer Sajid
- Department of Computer Software Engineering, Military College of Signals (MCS), National University of Science and Technology, Islamabad 44000, Pakistan; (M.Z.S.)
| | - Muhammad Fareed Hamid
- Department of Electrical Engineering, Military College of Signals (MCS), National University of Science and Technology, Islamabad 44000, Pakistan
| | - Ayman Youssef
- Department of Computers and Systems, Electronics Research Institute, Cairo 12622, Egypt;
| | - Javeria Yasmin
- Department of Computer Software Engineering, Military College of Signals (MCS), National University of Science and Technology, Islamabad 44000, Pakistan; (M.Z.S.)
| | - Ganeshkumar Perumal
- College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia; (G.P.); (I.Q.)
| | - Imran Qureshi
- College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia; (G.P.); (I.Q.)
| | - Syed Muhammad Naqi
- Department of Computer Science, Quaid-i-Azam University, Islamabad 44000, Pakistan;
| | - Qaisar Abbas
- College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia; (G.P.); (I.Q.)
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Youssef A. Unleashing the AI revolution: exploring the capabilities and challenges of large language models and text-to-image AI programs. Ultrasound Obstet Gynecol 2023; 62:308-312. [PMID: 37329526 DOI: 10.1002/uog.26297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/19/2023]
Affiliation(s)
- A Youssef
- Obstetric and Prenatal Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
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Youssef A, Lashley EELO, Vermeulen N, van der Hoorn MLP. Identifying discrepancies between clinical practice and evidence-based guideline in recurrent pregnancy loss care, a tool for clinical guideline implementation. BMC Pregnancy Childbirth 2023; 23:544. [PMID: 37507697 PMCID: PMC10386208 DOI: 10.1186/s12884-023-05869-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/23/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Practice variation in recurrent pregnancy loss (RPL) care is common. International guidelines vary in their recommendations for the management of RPL couples, which could lead to an increase of cross border reproductive care. Currently, the Dutch RPL guideline is being adapted from the European Society for Human Reproduction and Embryology (ESHRE) guideline. We aim to identify discrepancies between RPL guidelines and RPL practice. These discrepancies could be considered in the development of a new guideline and implementation strategies to promote adherence to new recommendations. METHODS A nationwide survey on the management of RPL patients was conducted across all 107 hospital-based obstetrics and gynaecology practices in the Netherlands. The survey was sent via the Dutch Society for Obstetricians and Gynaecologists to all affiliated clinicians. The questionnaire consisted of 36 questions divided in four sections: clinician's demographics, RPL definition, investigations and therapy. The data were compared to the recommendations given by the Dutch national guideline and the most recent guideline of the ESHRE. RESULTS All hospital-based practices (100%; n = 107) filled in the online questionnaire. The majority of respondents defined RPL similarly, as two or more pregnancy losses (87.4%), not obligatory consecutive (93.1%). More than half of respondents routinely perform thrombophilia screening ( 58%), although not advised by the ESHRE, while thyroid function (57%), thyroid auto-immunity (27%) and β2-glycoprotein antibodies (42%) in the context of antiphospholipid syndrome (APS) are recommended but investigated less often. Regarding parental karyotyping, 20% of respondents stated they always perform parental karyotyping, without prior risk assessment. because of RPL. Treatment for hereditary thrombophilia was frequently (43.8% (n = 137)) prescribed although not recommended. And finally, a considerable part (12-16%) of respondents prescribe medication in case of unexplained RPL. CONCLUSION While many clinicians perform investigations recommended by the ESHRE, there is a considerable variation of RPL practice in the Netherlands. We identified discrepancies between RPL guidelines and RPL practice, providing possibilities to focus on multifaceted implementation strategies, such as educational intervention, local consensus processes and auditing and feedback. This will improve the quality of care provided to RPL patients and may diminish the necessity felt by patients to turn to multiple opinions or cross border reproductive care.
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Affiliation(s)
- A Youssef
- Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands.
| | - E E L O Lashley
- Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
| | - N Vermeulen
- European Society of Human Reproduction and Embryology, Nijverheidslaan 3 (BXL 7 - Gebouw 1), Strombeek, Bever, B - 1853, Belgium
| | - M L P van der Hoorn
- Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
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Youssef A, Mohammed BK, Prasad A, del Aguila A, Bassi G, Yang W, Ulloa L. Splenic SUMO1 controls systemic inflammation in experimental sepsis. Front Immunol 2023; 14:1200939. [PMID: 37520526 PMCID: PMC10374847 DOI: 10.3389/fimmu.2023.1200939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction The recent discovery of TAK981(Subasumstat), the first-in-class selective inhibitor of SUMOylation, enables new immune treatments. TAK981 is already in clinical trials to potentiate immunotherapy in metastatic tumors and hematologic malignancies. Cancer patients have more than ten times higher risk of infections, but the effects of TAK981 in sepsis are unknown and previous studies on SUMO in infections are conflicting. Methods We used TAK981 in two sepsis models; polymicrobial peritonitis (CLP) and LPS endotoxemia. Splenectomy was done in both models to study the role of spleen. Western blotting of SUMO-conjugated proteins in spleen lysates was done. Global SUMO1 and SUMO3 knockout mice were used to study the specific SUMO regulation of inflammation in LPS endotoxemia. Splenocytes adoptive transfer was done from SUMO knockouts to wild type mice to study the role of spleen SUMOylation in experimental sepsis. Results and discussion Here, we report that inhibition of SUMOylation with TAK981 improved survival in mild polymicrobial peritonitis by enhancing innate immune responses and peritoneal bacterial clearance. Thus, we focused on the effects of TAK981 on the immune responses to bacterial endotoxin, showing that TAK981 enhanced early TNFα production but did not affect the resolution of inflammation. Splenectomy decreased serum TNFα levels by nearly 60% and TAK981-induced TNFα responses. In the spleen, endotoxemia induced a distinct temporal and substrate specificity for SUMO1 and SUMO2/3, and both were inhibited by TAK981. Global genetic depletion of SUMO1, but not SUMO3, enhanced TNFα production and metabolic acidosis. The transfer of SUMO1-null, but not wild-type, splenocytes into splenectomized wild-type mice exacerbated TNFα production and metabolic acidosis in endotoxemia. Conclusion These results suggest that specific regulation of splenic SUMO1 can modulate immune and metabolic responses to bacterial infection.
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Sajid MZ, Qureshi I, Abbas Q, Albathan M, Shaheed K, Youssef A, Ferdous S, Hussain A. Mobile-HR: An Ophthalmologic-Based Classification System for Diagnosis of Hypertensive Retinopathy Using Optimized MobileNet Architecture. Diagnostics (Basel) 2023; 13:diagnostics13081439. [PMID: 37189539 DOI: 10.3390/diagnostics13081439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Hypertensive retinopathy (HR) is a serious eye disease that causes the retinal arteries to change. This change is mainly due to the fact of high blood pressure. Cotton wool patches, bleeding in the retina, and retinal artery constriction are affected lesions of HR symptoms. An ophthalmologist often makes the diagnosis of eye-related diseases by analyzing fundus images to identify the stages and symptoms of HR. The likelihood of vision loss can significantly decrease the initial detection of HR. In the past, a few computer-aided diagnostics (CADx) systems were developed to automatically detect HR eye-related diseases using machine learning (ML) and deep learning (DL) techniques. Compared to ML methods, the CADx systems use DL techniques that require the setting of hyperparameters, domain expert knowledge, a huge training dataset, and a high learning rate. Those CADx systems have shown to be good for automating the extraction of complex features, but they cause problems with class imbalance and overfitting. By ignoring the issues of a small dataset of HR, a high level of computational complexity, and the lack of lightweight feature descriptors, state-of-the-art efforts depend on performance enhancement. In this study, a pretrained transfer learning (TL)-based MobileNet architecture is developed by integrating dense blocks to optimize the network for the diagnosis of HR eye-related disease. We developed a lightweight HR-related eye disease diagnosis system, known as Mobile-HR, by integrating a pretrained model and dense blocks. To increase the size of the training and test datasets, we applied a data augmentation technique. The outcomes of the experiments show that the suggested approach was outperformed in many cases. This Mobile-HR system achieved an accuracy of 99% and an F1 score of 0.99 on different datasets. The results were verified by an expert ophthalmologist. These results indicate that the Mobile-HR CADx model produces positive outcomes and outperforms state-of-the-art HR systems in terms of accuracy.
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Affiliation(s)
- Muhammad Zaheer Sajid
- Department of Computer Software Engineering, MCS, National University of Science and Technology, Islamabad 44000, Pakistan
| | - Imran Qureshi
- College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia
| | - Qaisar Abbas
- College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia
| | - Mubarak Albathan
- College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11432, Saudi Arabia
| | - Kashif Shaheed
- Department of Multimedia Systems, Faculty of Electronics, Telecommunication and Informatics, Gdansk University of Technology, 80-233 Gdansk, Poland
| | - Ayman Youssef
- Department of Computers and Systems, Electronics Research Institute, Cairo 12622, Egypt
| | - Sehrish Ferdous
- Department of Software Engineering, National University of Modern Languages, Rawalpindi 44000, Pakistan
| | - Ayyaz Hussain
- Department of Computer Science, Quaid-i-Azam University, Islamabad 44000, Pakistan
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Bhakta P, Hunzeker ZE, Garcia JD, Youssef A, Grant BJ, Alfattal R, Weaver D, Bhargava P, Rischall A, Musunuru T, Muthukumarana PV, Mallick J, Lyapichev KA. Pathological fracture due to primary bone lymphoma in a patient with a history of prostate cancer: A case report and review of literature. Front Oncol 2023; 13:1100559. [PMID: 37007154 PMCID: PMC10061010 DOI: 10.3389/fonc.2023.1100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Primary bone lymphoma (PBL) is a rare extranodal presentation within lymphomas and primary bone malignancies. Pathologic fracture (PF) is a common complication of metastatic bone disease but is, rarely, the presentation of a primary bone tumor. We report a case of an 83-year-old man with a history of untreated prostate cancer, presenting with atraumatic fracture of his left femur after months of intermittent pains and weight loss. Radiographic workup revealed a lytic lesion suspicious for PF secondary to metastatic prostate cancer; however, initial core biopsy results were inconclusive for malignancy. A complete blood count with differential and complete metabolic panel was within normal limits. During surgical fixation and nailing of the femur, a reaming biopsy was performed as a repeat measure and revealed diffuse large B-cell lymphoma. Staging with positron emission tomography and computed tomography found no evidence of lymphatic or visceral involvement and chemotherapy was promptly initiated. This case highlights the diagnostic workup challenges for PF secondary to PBL, especially in the setting of concurrent malignancy. Because of the non-specific presentation of a lytic lesion on imaging associated with atraumatic fracture, we highlight PBL as an important diagnostic consideration.
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Affiliation(s)
- Pooja Bhakta
- Department of Internal Medicine, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Zachary E. Hunzeker
- John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Juan D. Garcia
- Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Ayman Youssef
- John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Bradley J. Grant
- Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Rasha Alfattal
- Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Dylan Weaver
- Department of Radiology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Peeyush Bhargava
- Department of Radiology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Ariel Rischall
- Division of Hematology and Oncology, Department of Internal Medicine, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Tejo Musunuru
- Division of Hematology and Oncology, Department of Internal Medicine, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Palawinnage V. Muthukumarana
- Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Jayati Mallick
- Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Kirill A. Lyapichev
- Department of Pathology, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States
- *Correspondence: Kirill A. Lyapichev,
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Gharib K, Nassar A, Youssef A, Bessar H. Dermoscopic approach for differential diagnosing of autoimmune bullous disease: pemphigus vulgaris, pemphigus foliaceus, and IgA pemphigus. Int J Dermatol 2023; 62:770-775. [PMID: 36866791 DOI: 10.1111/ijd.16623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 01/08/2023] [Accepted: 02/07/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Dermoscopy is a noninvasive technique for the evaluation of different pigments and microstructures of the epidermis, dermoepidermal junction, and papillary dermis that are not apparent to the naked eye, which therefore improves diagnostic accuracy. AIM OF THE STUDY This study aims to describe the characteristic dermoscopic features of bullous diseases and analyze the characteristic dermoscopic features of bullous diseases of the skin and hair. PATIENTS AND METHODS A descriptive study was conducted to describe and analyze the characteristic dermoscopic features of bullous diseases in the Zagazig University Hospitals. RESULTS This study enrolled 22 patients. Dermoscopy revealed yellow hemorrhagic crusts in all patients and white yellow structure with red halo in 90.9% of patients. Pemphigus vulgaris patients were identified by the presence of dermoscopic clues such as bluish deep discoloration, tubular scaling, black dots, hair casts, hair tufts, yellow dots with whitish halos (fried egg sign) and yellow follicular pustules that are not seen in pemphigus foliaceus and IgA pemphigus. DISCUSSION Dermoscopy is an important tool that serves as a link between clinical and histopathological diagnoses, and it can easily be used in daily practice. Several suggestive dermoscopic features can help in the differential diagnosis of autoimmune bullous disease but only after making a provisional clinical diagnosis. Dermoscopy is a very useful tool in the differentiation of pemphigus subtypes.
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Affiliation(s)
- Khaled Gharib
- Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amani Nassar
- Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ayman Youssef
- Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hagar Bessar
- Department of Dermatology, Venerology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Attia M, Mahmoud NED, Youssef A. Spectrophotometric Method Development and Validation for the Determination of Molnupiravir in Bulk Powder and Pharmaceutical Formulation. Egypt J Chem 2023. [DOI: 10.21608/ejchem.2023.135533.5970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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El A, Kasmy Z, Elqatni M, Reggad A, Youssef S, Yassine E, Youssef A, Yassine E, Ennibi K. Présentation clinique atypique d’une localisation exceptionnelle d’une actinomycose. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bhakta P, Youssef A, Bigham L, Mallick J, Bhargava P, Rawas F, Weaver D, Hunzeker ZE, Dong J, Willis M, Qiu S, Nawgiri R, Iguh CCC, Lyapichev KA. Proposal of Diagnostic Approach of Periodontal Primary Non Hodgkin Lymphoma of Bone with Flow Cytometry as an Essential Diagnostic Component. Head Neck Pathol 2022; 16:1091-1102. [PMID: 35802244 PMCID: PMC9729681 DOI: 10.1007/s12105-022-01469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary bone lymphoma is a rare type of lymphoid neoplasm with favorable prognosis, where Primary Non Hodgkin Lymphoma of bone (PB-NHL) is most common with the subtype. Amongst PB-NHL, diffuse large Bcell lymphoma represents the majority of cases. The mandible is a very uncommon site of involvement, presenting as a painful bone mass with high suspicion of osteomyelitis. METHODS We report the case of a 45-year-old male with no significant past medical history who was admitted to the hospital with a large right jaw mass and pain after recent tooth removal. The original tissue biopsy was not diagnostic, and cultures were found to be negative for microorganisms. Due to enlargement of the mass, a fine needle aspiration (FNA) was done. At the time of rapid onsite evaluation of the FNA, atypical lymphoid cells were seen, and material was obtained for flow cytometry (FC) evaluation. This revealed an aberrant clonal B-cell population. The consequent immunohistochemical evaluation of original material supported the diagnosis of PB-NHL. After chemotherapy patient improved. RESULTS After an extensive English language literature review, we identified and summarized the clinical presentations, diagnostic procedures, histopathologic features, treatment methods, and outcomes of forty-two cases of periodontal PB-NHL. Based on our findings, we propose a set of clinical features at initial presentation to increase the clinical suspicion of periodontal PB-NHL for practitioners. CONCLUSION Based on our institution's experience and the literature review conclusions, we propose the University of Texas Medical Branch diagnostic approach for PB-NHL and suggest that FNA and FC should be utilized as the essential diagnostic component. The fast and efficient diagnosis of PB-NHL can facilitate the correct treatment and sufficiently improve patient care.
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Affiliation(s)
- Pooja Bhakta
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Ayman Youssef
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Lindsay Bigham
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Jayati Mallick
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, Galveston, TX USA
| | - Faisal Rawas
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Dylan Weaver
- Department of Radiology, University of Texas Medical Branch, Galveston, TX USA
| | - Zachary E. Hunzeker
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Jianli Dong
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Maurice Willis
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Suimin Qiu
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Ranjana Nawgiri
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | | | - Kirill A. Lyapichev
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
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Harfouch RM, Alkhaier Z, Ismail S, Youssef A, Alhasan AA, Bouali F, Shaaban R, Abdullah N, Al-Shehabi Z, Elshimali Y. Epidemiology and risk factors of colorectal cancer in Syria: a single-center retrospective study. Eur Rev Med Pharmacol Sci 2022; 26:4654-4658. [PMID: 35856355 DOI: 10.26355/eurrev_202207_29187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Colorectal cancer represents the third most common malignancy and the second leading cause of cancer deaths worldwide. Many factors contribute to the risk of developing colorectal carcinoma including diet, lifestyle, age, and genetic abnormalities. Recent findings have shown a considerable increase in the incidence rate of CRC in developing countries. However, there is little information regarding its incidence in the Middle East countries, including Syria. With our manuscript we aimed at presenting the first large epidemiological study regarding colorectal carcinoma incidence in Syria. PATIENTS AND METHODS We conducted a retrospective study on colorectal carcinoma cases at our institution from 2014 to 2018. The data include the cases that were diagnosed and recorded based on multiple parameters including gender, age, year of diagnosis, city of origin, and profession. RESULTS The number of colorectal cancer cases was 1,117 out of 13,589 cases of all malignant tumors recorded from 2014 to 2018, with an annual average incidence of 8.2%. There was a statistically significant difference in CRC cases according to age and gender. We also found a statistically significant difference according to physical activity and occupation. CONCLUSIONS These results demonstrate that risk factors related to colorectal cancer incidence in Syria mainly include male sex, age over 50 years old, and occupation with no physical activity.
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Affiliation(s)
- R M Harfouch
- Department of Microbiology and Biochemistry, Faculty of Pharmacy, Al-Sham Private University (ASPU), Latakia, Syria.
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Manickavasagar R, Chemmanam T, Youssef A, Agarwal A, Prentice DA, Irish AB. The extrapyramidal syndromes of chronic kidney disease and dialysis (EPS-CKDD): diagnostic criteria, risk factors and prognosis. QJM 2022; 115:359-366. [PMID: 34010386 DOI: 10.1093/qjmed/hcab140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/04/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Acute extrapyramidal movement disorders in dialysis patients are rare, inconsistently defined and have uncertain aetiology and prognosis. AIM Define diagnostic criteria, prognosis and risk factors. DESIGN AND METHODS Retrospective case series review of 20 patients (14 female, mean age 62 years) receiving dialysis for a median of 15 (interquartile range 4-35) months who presented with acute parkinsonism (AP = 11) or chorea/athetosis (CA = 9). RESULTS All patients had type 2 diabetes (HbA1c 6.8 ± 1.0) and had received metformin. Lactic acidosis was present in 2 patients at presentation and serum lactate was elevated in 7/15 patients tested. No patient had abnormal copper or thyroid metabolism and 5/8 patients tested returned marginal abnormalities in heavy metal screening. Magnetic resonance imaging (MRI) revealed characteristic bilateral symmetric T2 hyperintensity of the basal ganglia (BG), predominantly putamen and globus pallidus (the lentiform nucleus) and more extensive involvement of the external and internal capsules in patients with AP presentation. Post-mortem demonstrated cytotoxic necrosis of the BG. Therapy included thiamine, intensive dialysis and cessation of metformin. Two patients died acutely, nine recovered and nine had residual symptoms. Median survival did not differ by presentation: AP 24 [95% confidence interval (CI) 21-27] and CA 33 (95% CI 32-35) months, P = 0.21. CONCLUSIONS There are two distinct clinical extrapyramidal movement disorders associated with specific diagnostic MRI imaging that support the diagnosis of the extrapyramidal syndromes of chronic kidney disease and dialysis. The associations with diabetes, metformin and metabolic acidosis suggest a common pathogenic mechanism but require additional study. Early recognition and treatment may improve outcomes.
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Affiliation(s)
- R Manickavasagar
- Department of Nephrology and Transplantation, Fiona Stanley Hospital, 11-15 Robin Warren Drive, Murdoch, WA 6150, Australia
| | - T Chemmanam
- Department of Neurology, Sir Charles Gairdner Hospital, Hospital Avenue Nedlands, Perth, WA 6009, Australia
| | - A Youssef
- Neurological Intervention and Imaging Service, Sir Charles Gairdner Hospital, Hospital Avenue Nedlands, 8 Verdun St, Nedlands, Perth, WA 6009, Australia
| | - A Agarwal
- Neurological Intervention and Imaging Service, Sir Charles Gairdner Hospital, Hospital Avenue Nedlands, 8 Verdun St, Nedlands, Perth, WA 6009, Australia
| | - D A Prentice
- Perron Institute for Neurological and Translational Science, 8 Verdun St, Nedlands, Perth, WA 6009, Australia
| | - A B Irish
- Department of Nephrology and Transplantation, Fiona Stanley Hospital, 11-15 Robin Warren Drive, Murdoch, WA 6150, Australia
- Faculty of Medicine and Health Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia
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Youssef A, van der Hoorn MLP, Dongen M, Visser J, Bloemenkamp K, van Lith J, van Geloven N, Lashley EELO. External validation of a frequently used prediction model for ongoing pregnancy in couples with unexplained recurrent pregnancy loss. Hum Reprod 2021; 37:393-399. [PMID: 34875054 DOI: 10.1093/humrep/deab264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/24/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the predictive performance of a currently recommended prediction model in an external Dutch cohort of couples with unexplained recurrent pregnancy loss (RPL)? SUMMARY ANSWER The model shows poor predictive performance on a new population; it overestimates, predicts too extremely and has a poor discriminative ability. WHAT IS KNOWN ALREADY In 50-75% of couples with RPL, no risk factor or cause can be determined and RPL remains unexplained. Clinical management in RPL is primarily focused on providing supportive care, in which counselling on prognosis is a main pillar. A frequently used prediction model for unexplained RPL, developed by Brigham et al. in 1999, estimates the chance of a successful pregnancy based on number of previous pregnancy losses and maternal age. This prediction model has never been externally validated. STUDY DESIGN, SIZE, DURATION This retrospective cohort study consisted of 739 couples with unexplained RPL who visited the RPL clinic of the Leiden University Medical Centre between 2004 and 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Unexplained RPL was defined as the loss of two or more pregnancies before 24 weeks, without the presence of an identifiable cause for the pregnancy losses, according to the ESHRE guideline. Obstetrical history and maternal age were noted at intake at the RPL clinic. The outcome of the first pregnancy after intake was documented. The performance of Brigham's model was evaluated through calibration and discrimination, in which the predicted pregnancy rates were compared to the observed pregnancy rates. MAIN RESULTS AND THE ROLE OF CHANCE The cohort included 739 women with a mean age of 33.1 years (±4.7 years) and with a median of three pregnancy losses at intake (range 2-10). The mean predicted pregnancy success rate was 9.8 percentage points higher in the Brigham model than the observed pregnancy success rate in the dataset (73.9% vs 64.0% (95% CI for the 9.8% difference 6.3-13.3%)). Calibration showed overestimation of the model and too extreme predictions, with a negative calibration intercept of -0.46 (95% CI -0.62 to -0.31) and a calibration slope of 0.42 (95% CI 0.11-0.73). The discriminative ability of the model was very low with a concordance statistic of 0.55 (95% CI 0.51-0.59). Recalibration of the Brigham model hardly improved the c-statistic (0.57; 95% CI 0.53-0.62). LIMITATIONS, REASONS FOR CAUTION This is a retrospective study in which only the first pregnancy after intake was registered. There was no time frame as inclusion criterium, which is of importance in the counselling of couples with unexplained RPL. Only cases with a known pregnancy outcome were included. WIDER IMPLICATIONS OF THE FINDINGS This is the first study externally validating the Brigham prognostic model that estimates the chance of a successful pregnancy in couples with unexplained RPL. The results show that the frequently used model overestimates the chances of a successful pregnancy, that predictions are too extreme on both the high and low ends and that they are not much more discriminative than random luck. There is a need for revising the prediction model to estimate the chance of a successful pregnancy in couples with unexplained RPL more accurately. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used and no competing interests were declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M L P van der Hoorn
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Dongen
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Visser
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - K Bloemenkamp
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J van Lith
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - N van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - E E L O Lashley
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
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Ambrosio M, Casadio P, Filipponi F, Borghese G, Youssef A, Seracchioli R. Decidualized endometrioma in a non-pregnant woman. Ultrasound Obstet Gynecol 2021; 58:781-782. [PMID: 33794041 DOI: 10.1002/uog.23643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Affiliation(s)
- M Ambrosio
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Policlinico di Sant'Orsola, DIMEC, University of Bologna, Bologna, Italy
| | - P Casadio
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Policlinico di Sant'Orsola, DIMEC, University of Bologna, Bologna, Italy
| | - F Filipponi
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Policlinico di Sant'Orsola, DIMEC, University of Bologna, Bologna, Italy
| | - G Borghese
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Policlinico di Sant'Orsola, DIMEC, University of Bologna, Bologna, Italy
| | - A Youssef
- Obstetric Unit, IRCCS Policlinico di Sant'Orsola, DIMEC, University of Bologna, Bologna, Italy
| | - R Seracchioli
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Policlinico di Sant'Orsola, DIMEC, University of Bologna, Bologna, Italy
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Iqbal Z, Youssef A, Abdaldayem A, Shaikh F. 1476 North Wales Vascular Surgery Zoom Webinar Teaching Programme for Medical Students and Junior Doctors. Br J Surg 2021. [PMCID: PMC8524477 DOI: 10.1093/bjs/znab259.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aim Surgical Education is now more widely delivered on virtual platforms due to the COVID-19 pandemic. Due to centralisation of Vascular Surgery services in North Wales to Glan Clwyd Hospital (Central), Medical Students, Junior Doctors and General Surgical Registrars have reduced exposure to the speciality and the management of common cases in neighbouring hospitals (East and West). Subsequently, we developed a regional virtual teaching programme to help bridge gaps in knowledge and to instil confidence when providing a service. Method We developed a 4-part didactic webinar educational programme which covered parts of the medical undergraduate and MRCS curricula pertaining to Vascular Surgery. Under/Postgraduate educational leads from Central, East and West were contacted to promote our programme. Webinars were delivered on ZOOM video conferencing once weekly throughout December 2020. Feedback forms were collected on Google Forms™ and used 5-point Linkert scales to grade responses and analysis of data was carried out on Microsoft Excel®. Results 186 feedback forms were collected and respondents reported significant improvements in knowledge in each of the subjects covered: [1] Abdominal Aortic Aneurysms - (2.59±1.07/5 to 4.23±0.65/5, p = <0.0001, n = 60), [2] Acute Limb Ischaemia – (2.55±1.11/5 to 4.21±0.72/5, p = <0.0001, n = 42); [3] Chronic Limb Ischaemia (2.57±1.03/5 to 4.23±0.77/5, p = <0.0001, n = 35); [4] Vascular Emergencies (2.94±1.28/5 to 4.37±0.63/5, p = <0.0001, n = 49). Overall topic interest, presentational skills and clinical usefulness was also rated highly. Conclusions Through this virtually delivered regional teaching programme, we successfully enhanced Vascular Surgery knowledge and addressed the educational needs of Medical Students and Junior Doctors across North Wales.
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Affiliation(s)
- Z Iqbal
- NHS Wales - Besti Cadwaladr University Health Board, Rhyl, United Kingdom
| | - A Youssef
- NHS Wales - Besti Cadwaladr University Health Board, Rhyl, United Kingdom
| | - A Abdaldayem
- NHS Wales - Besti Cadwaladr University Health Board, Rhyl, United Kingdom
| | - F Shaikh
- NHS Wales - Besti Cadwaladr University Health Board, Rhyl, United Kingdom
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Youssef A, Brunelli E, Fiorentini M, Lenzi J, Pilu G, El-Balat A. Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal. Ultrasound Obstet Gynecol 2021; 58:609-615. [PMID: 33847431 DOI: 10.1002/uog.23649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the feasibility and reliability of transperineal ultrasound in the assessment of fetal breech descent in the birth canal, by measuring the breech progression angle (BPA). METHODS Women with a singleton pregnancy with the fetus in breech presentation between 34 and 41 weeks' gestation were recruited. Transperineal ultrasound images were acquired in the midsagittal view for each woman, twice by one operator and once by another. Each operator measured the BPA after anonymization of the transperineal ultrasound images. BPA was defined as the angle between a line running along the long axis of the pubic symphysis and another line extending from the most inferior portion of the pubic symphysis tangentially to the lowest recognizable fetal part in the maternal pelvis. Each operator was blinded to all other measurements performed for each woman. Intra- and interobserver reproducibility of BPA measurement was evaluated using the intraclass correlation coefficient (ICC). To investigate the presence of any bias, intra- and interobserver agreement was also analyzed using Bland-Altman analysis. Student's t-test and Levene's W0 test were used to investigate whether a number of different clinical factors had an effect on systematic differences and homogeneity, respectively, between BPA measurements. RESULTS Overall, 44 women were included in the analysis. BPA was measured successfully by both operators on all images. Both intra- and interobserver agreement analyses showed excellent reproducibility in BPA measurement, with ICCs of 0.88 (95% CI, 0.80-0.93) and 0.83 (95% CI, 0.71-0.90), respectively. The mean difference between measurements was 0.4° (95% CI, -1.4 to 2.2°) for intraobserver repeatability and -0.4° (95% CI, -2.6 to 1.8°) for interobserver repeatability. The upper limits of agreement were 12.0° (95% CI, 8.9-15.1°) and 13.6° (95% CI, 9.9-17.3°) for intra- and interobserver repeatability, respectively. The lower limits of agreement were -11.2° (95% CI, -14.3 to -8.1°) and -14.4° (95% CI, -18.2 to -10.7°) for intra- and interobserver repeatability, respectively. No systematic difference between BPA measurements was found on either intra- or interobserver agreement analysis. None of the clinical factors examined (maternal body mass index, maternal age, gestational age at the ultrasound scan and parity) showed a statistically significant effect on intra- or interobserver reliability. CONCLUSIONS BPA represents a new feasible and highly reproducible measurement for the evaluation of fetal breech descent in the birth canal. Future studies assessing its usefulness in the prediction of successful external cephalic version and breech vaginal delivery are needed. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Youssef
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Brunelli
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M Fiorentini
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - J Lenzi
- Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - A El-Balat
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Frankfurt, Germany
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Youssef A. P–419 On prognosis after unexplained recurrent pregnancy losses (RPL); a systematic review and external validation of clinical prediction models. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Which models that predict pregnancy outcome in couples with unexplained RPL exist and what is the performance of the most used model?
Summary answer
We identified seven prediction models; none followed the recommended prediction model development steps. Moreover, the most used model showed poor predictive performance.
What is known already
RPL remains unexplained in 50–75% of couples For these couples, there is no effective treatment option and clinical management rests on supportive care. Essential part of supportive care consists of counselling on the prognosis of subsequent pregnancies. Indeed, multiple prediction models exist, however the quality and validity of these models varies. In addition, the prediction model developed by Brigham et al is the most widely used model, but has never been externally validated.
Study design, size, duration
We performed a systematic review to identify prediction models for pregnancy outcome after unexplained RPL. In addition we performed an external validation of the Brigham model in a retrospective cohort, consisting of 668 couples with unexplained RPL that visited our RPL clinic between 2004 and 2019.
Participants/materials, setting, methods
A systematic search was performed in December 2020 in Pubmed, Embase, Web of Science and Cochrane library to identify relevant studies. Eligible studies were selected and assessed according to the TRIPOD) guidelines, covering topics on model performance and validation statement. The performance of predicting live birth in the Brigham model was evaluated through calibration and discrimination, in which the observed pregnancy rates were compared to the predicted pregnancy rates.
Main results and the role of chance
Seven models were compared and assessed according to the TRIPOD statement. This resulted in two studies of low, three of moderate and two of above average reporting quality. These studies did not follow the recommended steps for model development and did not calculate a sample size. Furthermore, the predictive performance of neither of these models was internally- or externally validated.
We performed an external validation of Brigham model. Calibration showed overestimation of the model and too extreme predictions, with a negative calibration intercept of –0.52 (CI 95% –0.68 – –0.36), with a calibration slope of 0.39 (CI 95% 0.07 – 0.71). The discriminative ability of the model was very low with a concordance statistic of 0.55 (CI 95% 0.50 – 0.59).
Limitations, reasons for caution
None of the studies are specifically named prediction models, therefore models may have been missed in the selection process. The external validation cohort used a retrospective design, in which only the first pregnancy after intake was registered. Follow-up time was not limited, which is important in counselling unexplained RPL couples.
Wider implications of the findings: Currently, there are no suitable models that predict on pregnancy outcome after RPL. Moreover, we are in need of a model with several variables such that prognosis is individualized, and factors from both the female as the male to enable a couple specific prognosis.
Trial registration number
Not applicable
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Affiliation(s)
- A Youssef
- Leiden University Medical Center LUMC, Obstetrics and Gynaecology, Leiden, The Netherlands
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Lorey M, Borelli M, Äikäs L, Youssef A, Hermansson M, Kemppainen A, Ruhanen H, Ruuth M, Matikainen S, Kovanen P, Käkelä R, Boffa M, Koschinsky M, Öörni K. Lp(a) induces inflammasome activation in human macrophages. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Youssef A, Brunelli E, Azzarone C, Di Donna G, Casadio P, Pilu G. Fetal head progression and regression on maternal pushing at term and labor outcome. Ultrasound Obstet Gynecol 2021; 58:105-110. [PMID: 32730691 DOI: 10.1002/uog.22159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of our study was two-fold. First, to evaluate the association between the change in the angle of progression (AoP) on maternal pushing and labor outcome. Second, to assess the incidence and clinical significance of the reduction of AoP on maternal pushing. METHODS This was a prospective cohort study of nulliparous women with singleton pregnancy at term. AoP was measured at rest and on maximum Valsalva maneuver before the onset of labor, and the difference between AoP on maximum Valsalva and that at rest (ΔAoP) was calculated for each woman. Following delivery and data collection, we assessed the association between ΔAoP and various labor outcomes, including Cesarean section (CS), duration of the first, second and active second stages of labor, Apgar score and admission to the neonatal intensive care unit (NICU). The prevalence of women with reduction of AoP on maximum Valsalva maneuver (AoP-regression group) was calculated and its association with the mode of delivery and duration of different stages of labor was assessed. RESULTS Overall, 469 women were included in the analysis. Among these, 273 (58.2%) had spontaneous vaginal birth, 65 (13.9%) had instrumental delivery and 131 (27.9%) underwent CS. Women in the CS group were older, had narrower AoP at rest and on maximum Valsalva, higher rate of epidural administration and lower 1-min and 5-min Apgar scores in comparison with the vaginal-delivery group. ΔAoP was comparable between the two groups. On Pearson's correlation analysis, AoP at rest and on maximum Valsalva maneuver had a significant negative correlation with the duration of the first stage of labor. ΔAoP showed a significant negative correlation with the duration of the active second stage of labor (Pearson's r, -0.125; P = 0.02). Cox regression model analysis showed that ΔAoP was associated independently with the duration of the active second stage (hazard ratio, 1.014 (95% CI, 1.003-1.025); P = 0.012) after adjusting for maternal age and body mass index. AoP reduction on maximum Valsalva was found in 73 (15.6%) women. In comparison with women who showed no change or an increase in AoP on maximum Valsalva, the AoP-regression group did not demonstrate significant difference in maternal characteristics, mode of delivery, rate of epidural analgesia, duration of the different stages of labor or rate of NICU admission. CONCLUSIONS In nulliparous women at term before the onset of labor, narrower AoP at rest and on maximum Valsalva, reflecting fetal head engagement, is associated with a higher risk of Cesarean delivery. The increase in AoP from rest to Valsalva, reflecting more efficient maternal pushing, is associated with a shorter active second stage of labor. Fetal head regression on maternal pushing is present in about 16% of women and does not appear to have clinical significance. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Brunelli
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - C Azzarone
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Di Donna
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - P Casadio
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Del Forno S, Arena A, Pellizzone V, Lenzi J, Raimondo D, Cocchi L, Paradisi R, Youssef A, Casadio P, Seracchioli R. Assessment of levator hiatal area using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: randomized controlled trial. Ultrasound Obstet Gynecol 2021; 57:726-732. [PMID: 33428320 DOI: 10.1002/uog.23590] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Deep infiltrating endometriosis (DIE) is associated with chronic pelvic pain, dyspareunia and pelvic floor muscle hypertonia. The primary aim of this study was to evaluate the effect of pelvic floor physiotherapy (PFP) on the area of levator ani hiatus during Valsalva maneuver, assessed using transperineal ultrasound, in women with DIE suffering from superficial dyspareunia. METHODS This was a randomized controlled trial of 34 nulliparous women diagnosed with DIE and associated superficial dyspareunia. After an initial clinical examination, all patients underwent three-dimensional/four-dimensional (3D/4D) transperineal ultrasound to measure the levator hiatal area (LHA) at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver, and were asked to rate their pain symptoms using a numerical rating scale (NRS). Eligible women were assigned randomly (1:1 ratio) to no intervention (control group, 17 women) or treatment with five individual sessions of PFP (study group, 17 women). Four months after the first examination, all women underwent a second evaluation of pain symptoms and LHA on transperineal ultrasound. The primary outcome measure was the percentage change in LHA on maximum Valsalva maneuver between the baseline and follow-up examinations. The percentage changes in pain symptoms between the two examinations, including superficial and deep dyspareunia, dysmenorrhea, chronic pelvic pain, dysuria and dyschezia, were also evaluated. RESULTS Thirty women, comprising 17 in the study group and 13 in the control group, completed the study and were included in the analysis. The percentage change in LHA on maximum Valsalva maneuver between the two examinations was higher in the study group than in the control group (20.0 ± 24.8% vs -0.5 ± 3.3%; P = 0.02), indicating better pelvic floor muscle relaxation. After PFP treatment, the NRS score for superficial dyspareunia remained almost unchanged in the control group (median change in NRS (Δ-NRS), 0 (interquartile range (IQR), 0-0)) while a marked reduction was observed in the study group (median Δ-NRS, -3 (IQR, -4 to -2); P < 0.01). Moreover, there was a significant difference between the PFP and control groups with regards to the change in chronic pelvic pain (median Δ-NRS, 0 (IQR, -2 to 0) vs 0 (IQR, 0-1); P = 0.01). CONCLUSIONS In women with DIE, PFP seems to result in increased LHA on Valsalva maneuver, as observed by 3D/4D transperineal ultrasound, leading to improved superficial dyspareunia, chronic pelvic pain and pelvic floor muscle relaxation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Del Forno
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - A Arena
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - V Pellizzone
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - J Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - D Raimondo
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - L Cocchi
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - R Paradisi
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - A Youssef
- Obstetrics and Feto-Maternal Medicine Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - P Casadio
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - R Seracchioli
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
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Del Forno S, Arena A, Pellizzone V, Lenzi J, Raimondo D, Cocchi L, Paradisi R, Youssef A, Casadio P, Seracchioli R. Reply. Ultrasound Obstet Gynecol 2021; 57:850. [PMID: 33939209 DOI: 10.1002/uog.23637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- S Del Forno
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - A Arena
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - V Pellizzone
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - J Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - D Raimondo
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - L Cocchi
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - R Paradisi
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - A Youssef
- Obstetrics and Feto-Maternal Medicine Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - P Casadio
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - R Seracchioli
- Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
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Bessar H, Hammad NM, Ismail T, Teama MA, Youssef A. Serum angiopoietin-2 level as a novel potential biomarker in oral lichen planus. J Cosmet Dermatol 2021; 20:2940-2944. [PMID: 33394534 DOI: 10.1111/jocd.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lichen planus is a common chronic cutaneous inflammatory disease. Recent advances evidenced that angiogenesis is tightly connected to it. More recently, the endothelial specific growth factor angiopoietin-2 has been clarified to interact with vascular endothelial growth factor. Angiopoietin-2 level has not been investigated in lichen planus. AIM To evaluate serum level of angiopoietin-2 in cutaneous and oral lichen planus. METHODS Ninety patients were investigated, 45 patients with lichen planus. In addition to forty-five healthy control, the activity of the disease was estimated at the time of examination. The serum level of angiopoietin-2 had been estimated by enzyme-linked immunosorbent assay. The relationships between angiopoietin-2 serum level and disease severity, type of lichen, and visual analogue scale score (VAS) were determined. RESULTS The serum levels of angiopoietin-2 were substantially higher in patients with both cutaneous and oral lesions than patients with cutaneous lichen planus only (P < .001). CONCLUSIONS Serum angiopoietin-2 is elevated in patients compared with normal subjects and is correlated with the presence of oral lesions and disease severity, that reflects its role in angiogenesis and inflammation, and angiopoietin-2 serum level could be a potential marker for monitoring the oral lichen to identify possible malignant transformation.
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Affiliation(s)
- Hagar Bessar
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Noha M Hammad
- Department of Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Tawhed Ismail
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed AbdElkader Teama
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ayman Youssef
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Youssef A, Ibrahim K, Christoph M, Vondran M, Abugameh A, Rastan A, Ghazy T. Mechanical Unloading by Impella CP in Postinfarction Posterior Ventricular Septal Defect, Bridging to Repair: First Case Series. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Youssef A, Brunelli E, Montaguti E, Di Donna G, Dodaro MG, Bianchini L, Pilu G. Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement. Ultrasound Obstet Gynecol 2020; 56:921-927. [PMID: 31975450 DOI: 10.1002/uog.21982] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the association between pelvic floor dimensions in nulliparous women at term and fetal head engagement, as assessed by transperineal ultrasound. METHODS This was a prospective observational study of nulliparous women at term. Before the onset of labor, transperineal ultrasound was used to measure the anteroposterior diameter (APD) of the levator hiatus and the angle of progression (AoP) at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver (before and after visual feedback). We assessed the correlation between pelvic floor static and dynamic dimensions (levator hiatal APD and levator ani muscle coactivation) and AoP, which is an objective index of fetal head engagement. RESULTS In total, 282 women were included in the analysis. Among these, 211 (74.8%) women had a vaginal delivery while 71 (25.2%) had a Cesarean delivery. AoP was narrower in the Cesarean-delivery group at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva, whereas no differences in levator hiatal APD were found between the two groups. We found a negative correlation between levator hiatal APD at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva and the duration of the second stage of labor. There was a positive correlation between AoP and levator hiatal APD on maximum Valsalva maneuver after visual feedback (r = 0.15, P = 0.01). Women with levator ani muscle contraction on Valsalva maneuver (i.e. coactivation), both pre and post visual feedback, had a narrower AoP at rest and on maximum Valsalva. After visual feedback, women with levator ani muscle coactivation had a longer second stage of labor than did those without (80.8 ± 61.4 min vs 62.9 ± 43.4 min (P = 0.04)). CONCLUSIONS Smaller pelvic floor dimensions and levator ani muscle coactivation are associated with higher fetal head station and with a longer second stage of labor in nulliparous women at term. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Brunelli
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Di Donna
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M G Dodaro
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - L Bianchini
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Salman MA, Rabiee A, Salman A, Youssef A, E-D Shaaban H, Ftohy TE, Maurice KK, Balamoun H. Role of Vitamin D Supplements in Prevention of Hungry Bone Syndrome after Successful Parathyroidectomy for Primary Hyperparathyroidism: A Prospective Study. Scand J Surg 2020; 110:329-334. [PMID: 33019891 DOI: 10.1177/1457496920962601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We postulated that the preoperative correction of vitamin D levels can significantly reduce the incidence of hunger bone syndrome among patients undergoing parathyroidectomy for primary hyperparathyroidism. METHODS We performed a prospective, randomized, open-label study on 102 patients with primary hyperparathyroidism and coexisting vitamin D deficiency who were scheduled to undergo parathyroidectomy. Patients were divided into the following two groups: group I which included 52 patients who did not receive preoperative vitamin D supplementation; and group II which included 50 patients who received cholecalciferol 1000-2000 IU daily or 50000 IU weekly until they achieve vitamin D levels >20 ng/mL (group IIa = 25 patients) or vitamin D levels >30 ng/mL (group IIb = 25 patients). RESULTS The incidence of hunger bone syndrome in group IIb was lower than group I and group IIa (8% versus 16% versus 23%, respectively); however, this difference did not reach the level of statistical significance (p = 0.22). Patients with hunger bone syndrome were significantly younger and had higher serum phosphorus, alkaline phosphatase, magnesium, and bone mineral density at baseline than patients without hunger bone syndrome. On the other hand, patients with hunger bone syndrome had significantly lower 25-hydroxyvitamin D at baseline than patients without hunger bone syndrome (p = 0.001). The ROC curve showed that the baseline level of serum 25-hydroxyvitamin D was not an independent discriminator of hunger bone syndrome (area under curve = 0.21 (95% CI: 0.06-0.34); p = 0.011). CONCLUSION Preoperative course of vitamin D supplements has no preventive role on the postoperative incidence of hunger bone syndrome among patients with primary hyperparathyroidism and coexisting vitamin D deficiency undergoing parathyroidectomy.
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Affiliation(s)
- M A Salman
- General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - A Rabiee
- Internal Medicine Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - A Salman
- Internal Medicine Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - A Youssef
- Internal Medicine Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - H E-D Shaaban
- National Hepatology and Tropical Medicine Research Institute, Gastroenterology and Hepatology, Cairo, Egypt
| | - T E Ftohy
- Head and Neck Surgery, Sohag University, Sohag, Egypt
| | - K K Maurice
- General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - H Balamoun
- General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
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Casadio P, Youssef A, Arena A, Gamal N, Pilu G, Seracchioli R. Increased rate of ruptured ectopic pregnancy in COVID-19 pandemic: analysis from the North of Italy. Ultrasound Obstet Gynecol 2020; 56:289. [PMID: 32573042 PMCID: PMC7361714 DOI: 10.1002/uog.22126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Affiliation(s)
- P. Casadio
- Gynecology and Human Reproduction Physiopathology, Department of Obstetrics and Gynecology, DIMECSant'Orsola‐Malpighi University HospitalBolognaItaly
| | - A. Youssef
- Obstetrics and Prenatal Medicine UnitSant'Orsola‐Malpighi University HospitalBolognaItaly
| | - A. Arena
- Gynecology and Human Reproduction Physiopathology, Department of Obstetrics and Gynecology, DIMECSant'Orsola‐Malpighi University HospitalBolognaItaly
| | - N. Gamal
- Immunohematology and Transfusion Medicine ServiceAzienda Ospedaliero‐Universitaria Policlinico di ModenaModenaItaly
| | - G. Pilu
- Obstetrics and Prenatal Medicine UnitSant'Orsola‐Malpighi University HospitalBolognaItaly
| | - R. Seracchioli
- Gynecology and Human Reproduction Physiopathology, Department of Obstetrics and Gynecology, DIMECSant'Orsola‐Malpighi University HospitalBolognaItaly
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Youssef A, Idris O, Dodaro MG, Badr I, Di Donna G, Kamel R. Three-dimensional ultrasound assessment of pelvic floor: impact of theoretical and practical course on caregiver accuracy. Ultrasound Obstet Gynecol 2020; 55:554-556. [PMID: 31483892 DOI: 10.1002/uog.20863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - O Idris
- Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, Cairo, Egypt
| | - M G Dodaro
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - I Badr
- Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, Cairo, Egypt
| | - G Di Donna
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - R Kamel
- Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, Cairo, Egypt
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Darwich D, Youssef A, Zaraket H. Low-cost multiple FBG interrogation technique for static applications. Opt Lett 2020; 45:1116-1119. [PMID: 32108784 DOI: 10.1364/ol.386053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
In this Letter, a low-cost interrogation technique for multiple fiber Bragg gratings (FBGs) is demonstrated. The design utilizes the major advantage of the distributed feedback lasers, which is tuning their emitted wavelength by current modulation and temperature variation. The sensitivity of this method and the influence of optical losses on the measurement have been carefully studied, and an accuracy of 5 pm is achieved.
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Moussa B, Nor ELdin N, Abd Elmageed A, Youssef A. The Predictive Value of the Sliding Sign in the Evaluation of Deep Infiltrating Endometriosis. Minia Journal of Medical Research 2020; 31:315-322. [DOI: 10.21608/mjmr.2022.221542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Koller C, Alzweri L, Tsambarlis P, Youssef A, Jansen D, Hellstrom W. 361 Evolution of Radial Forearm Free Flap Neophallus Construction for Future Prosthetic Intervention and Decreased Urinary Complications in Cis-Male Patients. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kahrs BH, Usman S, Ghi T, Youssef A, Torkildsen EA, Lindtjørn E, Østborg TB, Benediktsdottir S, Brooks L, Harmsen L, Salvesen KÅ, Lees CC, Eggebø TM. Descent of fetal head during active pushing: secondary analysis of prospective cohort study investigating ultrasound examination before operative vaginal delivery. Ultrasound Obstet Gynecol 2019; 54:524-529. [PMID: 31115115 DOI: 10.1002/uog.20348] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate if descent of the fetal head during active pushing is associated with duration of operative vaginal delivery, mode of delivery and neonatal outcome in nulliparous women with prolonged second stage of labor. METHODS This was a prospective cohort study of nulliparous women with prolonged second stage of labor, conducted between November 2013 and July 2016 in five European countries. Fetal head descent was measured using transperineal ultrasound. Head-perineum distance (HPD) was measured between contractions and on maximum contraction during active pushing, and the difference between these values (ΔHPD) was calculated. The main outcome was duration of operative vaginal delivery, estimated using survival analysis to calculate hazard ratios (HRs) for vaginal delivery, with values > 1 indicating a shorter duration. HR was adjusted for prepregnancy body mass index, maternal age, induction of labor, augmentation with oxytocin and use of epidural analgesia. Pregnancies were grouped according to ΔHPD quartile, and delivery mode and neonatal outcome were compared between groups. RESULTS The study population comprised 204 women. Duration of vacuum extraction was shorter with increasing ΔHPD. Estimated mean duration was 10.0, 9.0, 8.8 and 7.5 min in pregnancies with ΔHPD in the first to fourth quartiles, respectively, and the adjusted HR for vaginal delivery, using increasing ΔHPD as a continuous variable, was 1.04 (95% CI, 1.01-1.08). Mean ΔHPD was 7 mm (range, -10 to 37 mm). ΔHPD was either negative or ≤ 2 mm in the lowest quartile. In this group, 7/50 (14%) pregnancies were delivered by Cesarean section, compared with 8/154 (5%) of those with ΔHPD > 2 mm (P < 0.05). There was no significant association between umbilical artery pH < 7.10 or 5-min Apgar score < 7 and ΔHPD quartile. CONCLUSION Minimal or no fetal head descent during active pushing was associated with longer duration of operative vaginal delivery and higher frequency of Cesarean section in nulliparous women with prolonged second stage of labor. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B H Kahrs
- National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S Usman
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T Ghi
- Parma University Hospital, Parma, Italy
| | - A Youssef
- St Orsola Malpighi University Hospital, Bologna, Italy
| | - E A Torkildsen
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - E Lindtjørn
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - T B Østborg
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - S Benediktsdottir
- Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland
| | - L Brooks
- Hvidovre University Hospital, Copenhagen, Denmark
| | - L Harmsen
- Hvidovre University Hospital, Copenhagen, Denmark
| | - K Å Salvesen
- National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - C C Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T M Eggebø
- National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Youssef A, Montaguti E, Dodaro MG, Kamel R, Rizzo N, Pilu G. Levator ani muscle coactivation at term is associated with longer second stage of labor in nulliparous women. Ultrasound Obstet Gynecol 2019; 53:686-692. [PMID: 30353589 DOI: 10.1002/uog.20159] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/05/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the effect of levator ani muscle (LAM) coactivation at term on outcome of labor in nulliparous women. METHODS This was a prospective study of 284 low-risk nulliparous women with a singleton pregnancy at term recruited before the onset of labor. The anteroposterior diameter of the levator hiatus was measured in each woman on transperineal ultrasound at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver before and after visual feedback. LAM coactivation was defined as a reduction in the anteroposterior diameter of the levator hiatus on maximum Valsalva maneuver in comparison with that at rest. The association of pelvic hiatal diameter values and LAM coactivation with mode of delivery and duration of labor was assessed. RESULTS No significant difference was found between women who underwent Cesarean delivery and those who had a vaginal delivery with regard to the anteroposterior diameter of the levator hiatus at rest, on pelvic floor muscle contraction and on Valsalva maneuver. Longer second stage of labor was associated with shorter anteroposterior diameter of the levator hiatus on all assessments, but in particular at rest and on Valsalva both before and after visual feedback. LAM coactivation was found in 89 (31.3%) and 75 (26.4%) women before and after visual feedback, respectively. Post visual feedback, women with LAM coactivation had a significantly longer second stage of labor than did those without LAM coactivation (83 ± 63 vs 63 ± 42 min; P = 0.006). On Cox regression analysis, LAM coactivation post visual feedback was an independent predictor of longer second stage of labor (adjusted hazard ratio, 1.499 (95% CI, 1.076-2.087); P = 0.017). CONCLUSION LAM coactivation in nulliparous women at term is associated with a longer second stage of labor. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M G Dodaro
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - R Kamel
- Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, Egypt
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Kamel R, Youssef A. How reliable is fetal occiput and spine position assessment prior to induction of labor? Ultrasound Obstet Gynecol 2019; 53:535-540. [PMID: 29947161 DOI: 10.1002/uog.19169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/16/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess the reliability of fetal occiput and spine position determination in nulliparous women prior to induction of labor (IOL), and to evaluate identification of fetal occiput and spine positions prior to IOL in the prediction of labor outcome. METHODS A series of 136 nulliparous women were recruited prospectively, immediately after the decision to perform IOL was made. Transabdominal ultrasound was performed to determine fetal head and spine positions. After at least 1 h, and prior to IOL, fetal occiput and spine positions were reassessed. Fetal occiput and spine positions were then compared between women who underwent vaginal delivery and those who delivered by Cesarean section. RESULTS On the first and second assessments, respectively, fetal occiput position was anterior in 55 (40.4%) and 62 (45.6%) women, transverse in 52 (38.2%) and 49 (36.0%) women, and posterior in 29 (21.3%) and 25 (18.4%) women, while fetal spine position was anterior in 58 (42.6%) and 52 (38.2%) women, transverse in 42 (30.9%) and 50 (36.8%) women, and posterior in 36 (26.5%) and 34 (25.0%) women. Discordance between the first and second assessments of fetal occiput position was identified in 34 (25.0%) women, whereas discordance of fetal spine position was observed in 40 (29.4%) women. The incidence of fetal occiput posterior position in women undergoing Cesarean section was comparable to that in the vaginal-delivery group (19 (18.8%) vs 6 (17.1%); P = 0.826), which was similarly the case for fetal posterior spine position (27 (26.7%) vs 7 (20%); P = 0.428). Women with fetal occiput posterior position had a longer induction-to-delivery interval in comparison to those with non-occiput posterior fetal position (1786 ± 805 vs 1347 ± 784 min; P = 0.013). CONCLUSIONS Fetal occiput and spine positions are dynamic in a considerable proportion of women undergoing IOL, and their assessment does not seem to correlate with mode of delivery. Occiput and spine position assessment in women prior to IOL is unlikely to be clinically useful. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Kamel
- Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, Cairo, Egypt
| | - A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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McManigle W, Youssef A, Sarantopoulos S. B cells in chronic graft-versus-host disease. Hum Immunol 2019; 80:393-399. [PMID: 30849450 DOI: 10.1016/j.humimm.2019.03.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/19/2019] [Accepted: 03/04/2019] [Indexed: 02/06/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (alloHCT) is the definitive therapy for numerous otherwise incurable hematologic malignancies and non-malignant diseases. The genetic disparity between donor and recipient both underpins therapeutic effects and confers donor immune system-mediated damage in the recipient, called graft-versus-host disease (GVHD). Chronic GVHD (cGVHD) is a major cause of late post-transplant morbidity and mortality. B cells have a substantiated role in cGVHD pathogenesis, as first demonstrated by clinical response to the anti-CD20 monoclonal antibody, rituximab. Initiation of CD20 blockade is met at times with limited therapeutic success that has been associated with altered peripheral B cell homeostasis and excess B Cell Activating Factor of the TNF family (BAFF). Increased BAFF to B cell ratios are associated with the presence of circulating, constitutively activated B cells in patients with cGVHD. These cGVHD patient B cells have increased survival capacity and signal through both BAFF-associated and B Cell Receptor (BCR) signaling pathways. Proximal BCR signaling molecules, Syk and BTK, appear to be hyper-activated in cGVHD B cells and can be targeted with small molecule inhibitors. Murine studies have confirmed roles for Syk and BTK in development of cGVHD. Emerging evidence has prompted investigation of several small molecule inhibitors in an attempt to restore B cell homeostasis and potentially target rare, pathologic B cell populations.
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Affiliation(s)
- William McManigle
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, NC, USA; Department of Medicine, Duke University, Durham, NC, USA
| | - Ayman Youssef
- Adult Hematology and Bone Marrow Transplantation, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Stefanie Sarantopoulos
- Department of Medicine, Duke University, Durham, NC, USA; Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA.
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Fuchs A, Youssef A, Seher A, Hochleitner G, Dalton PD, Hartmann S, Brands RC, Müller-Richter UDA, Linz C. Medical-grade polycaprolactone scaffolds made by melt electrospinning writing for oral bone regeneration - a pilot study in vitro. BMC Oral Health 2019; 19:28. [PMID: 30709394 PMCID: PMC6359770 DOI: 10.1186/s12903-019-0717-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/21/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The spectrum of indications for the use of membranes and scaffolds in the field of oral and maxillofacial surgery includes, amongst others, guided bone regeneration (GBR). Currently available membrane systems face certain disadvantages such as difficult clinical handling, inconsistent degradation, undirected cell growth and a lack of stability that often complicate their application. Therefore, new membranes which can overcome these issues are of great interest in this field. METHODS In this pilot study, we investigated polycaprolactone (PCL) scaffolds intended to enhance oral wound healing by means of melt electrospinning writing (MEW), which allowed for three-dimensional (3D) printing of micron scale fibers and very exact fiber placement. A singular set of box-shaped scaffolds of different sizes consisting of medical-grade PCL was examined and the scaffolds' morphology was evaluated via scanning electron microscopy (SEM). Each prototype sample with box sizes of 225 μm, 300 μm, 375 μm, 450 μm and 500 μm was assessed for cytotoxicity and cell growth by seeding each scaffold with human osteoblast-like cell line MG63. RESULTS All scaffolds demonstrated good cytocompatibility according to cell viability, protein concentration, and cell number. SEM analysis revealed an exact fiber placement of the MEW scaffolds and the growth of viable MG63 cells on them. For the examined box-shaped scaffolds with pore sizes between 225 μm and 500 μm, a preferred box size for initial osteoblast attachment could not be found. CONCLUSIONS These well-defined 3D scaffolds consisting of medical-grade materials optimized for cell attachment and cell growth hold the key to a promising new approach in GBR in oral and maxillofacial surgery.
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Affiliation(s)
- A. Fuchs
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97080 Würzburg, Germany
| | - A. Youssef
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97080 Würzburg, Germany
| | - A. Seher
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97080 Würzburg, Germany
| | - G. Hochleitner
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97080 Würzburg, Germany
| | - P. D. Dalton
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97080 Würzburg, Germany
| | - S. Hartmann
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97080 Würzburg, Germany
| | - R. C. Brands
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97080 Würzburg, Germany
| | - U. D. A. Müller-Richter
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97080 Würzburg, Germany
| | - C. Linz
- Department of Oral and Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97080 Würzburg, Germany
- Interdisciplinary Center for Clinical Research, University Hospital Würzburg, Josef-Schneider-Straße 2, 97070 Würzburg, Germany
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Youssef A. Sharing knowledge: the White Journal and the power of social networks. Ultrasound Obstet Gynecol 2019; 53:279-280. [PMID: 30561115 DOI: 10.1002/uog.20200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 06/09/2023]
Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
- Social Media Editor of Ultrasound in Obstetrics & Gynecology, International Society of Ultrasound in Obstetrics and Gynecology
- Chair of ISUOG Continuous Medical Education (CME) Task Force, International Society of Ultrasound in Obstetrics and Gynecology
- Ambassador in Egypt and North Africa, International Society of Ultrasound in Obstetrics and Gynecology
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Youssef A, Salsi G, Cataneo I, Pacella G, Azzarone C, Paganotto MC, Krsmanovic J, Montaguti E, Cariello L, Bellussi F, Rizzo N, Pilu G. Fundal pressure in second stage of labor (Kristeller maneuver) is associated with increased risk of levator ani muscle avulsion. Ultrasound Obstet Gynecol 2019; 53:95-100. [PMID: 29749657 DOI: 10.1002/uog.19085] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the association between application of fundal pressure during the second stage of labor (Kristeller maneuver) and the risk of levator ani muscle (LAM) injury. METHODS This was a prospective case-control study of women recruited immediately after their first vaginal delivery in our university hospital between March 2014 and September 2016. Women who underwent the Kristeller maneuver were recruited as cases. For each case, a control (no Kristeller) was recruited matched for body mass index, use of epidural analgesia, duration of second stage of labor and birth weight. All women were invited to undergo four-dimensional (4D) transperineal ultrasound (TPU) 3-6 months postpartum. The main outcome measure was the presence of LAM avulsion on 4D-TPU. TPU results were compared between cases and controls. Multivariate logistic regression analysis was performed to identify independent risk factors for LAM avulsion. RESULTS During the study period, 134 women in the Kristeller maneuver group and 128 women in the control group underwent TPU assessment. Women who underwent the Kristeller maneuver had a higher prevalence of LAM avulsion than did controls (38/134 (28.4%) vs 18/128 (14.1%); P = 0.005). In addition, women in the Kristeller-maneuver group had a larger hiatal area on maximum Valsalva maneuver and a greater increase in hiatal area from rest to maximum Valsalva. On multivariate logistic regression analysis, use of the Kristeller maneuver was the only independent factor associated with LAM avulsion (odds ratio, 2.5 (95% CI, 1.29-4.51)). CONCLUSION The Kristeller maneuver is associated with an increased risk of LAM avulsion when applied in women during their first vaginal delivery. This should be taken into account when deciding to use fundal pressure to accelerate the second stage of labor and when counseling women following childbirth. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Salsi
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - I Cataneo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pacella
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - C Azzarone
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria Integrata di Verona, Verona, Italy
| | - M C Paganotto
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - J Krsmanovic
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
- Clinic for Gynecology and Obstetrics, University of Southampton, Kassel School of Medicine, Kassel, Germany
| | - E Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - L Cariello
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - F Bellussi
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Kunigelis K, Yang A, Youssef A. Endoscopic Assisted Retrosigmoid Approach for Cerebellopontine Angle Epidermoid Tumor. Skull Base Surg 2018; 79:S413-S414. [PMID: 30456046 PMCID: PMC6240417 DOI: 10.1055/s-0038-1669978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/12/2018] [Indexed: 10/29/2022]
Abstract
This case is a 20-year-old male, who presented with 1 month of right facial weakness (HB4) and complaints of ipsilateral eye dryness. He was initially treated for Bell's palsy with steroids and antiviral agents, but subsequently developed diplopia with right lateral gaze and underwent an MRI (magnetic resonance imaging). MRI demonstrated a 4.5 cm irregular lesion in the right cerebellopontine angle consistent with an epidermoid cyst. Because the tumor had grown with the development of the central nervous system, it has extended into different compartments, including the tentorial incisura and pineal region. A predefined surgical corridor created by the tumor facilitated access to the majority of the tumor through a retrosigmoid approach. Angled endoscopes (30-degree up and down) provided further visualization of tumor away from the line of sight of the microscope, thus allowing for gross total resection of the lesion. This video also demonstrates a sharp dissection technique necessary for safe removal of adherent tumor from critical neurovascular structures, including the basilar artery and several cranial nerves. The ipsilateral auditory evoked responses (ABRs) showed slight improvement from baseline toward the end of the case. A gross total resection was achieved, as shown by the MRI. The patient remained at his baseline cranial nerve (CN) V, VII, and VIII deficits during the immediate postoperative period.The link to the video can be found at: https://youtu.be/vCq5juJh8hk.
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Affiliation(s)
- Katherine Kunigelis
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, United States
| | - Alexander Yang
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, United States
| | - A. Youssef
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, United States
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Kunigelis K, Craig D, Yang A, Gubbels S, Youssef A. Presigmoid Approach to Dumbbell Trigeminal Schwannoma. Skull Base Surg 2018; 79:S391-S392. [PMID: 30456036 PMCID: PMC6240166 DOI: 10.1055/s-0038-1669977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/12/2018] [Indexed: 10/30/2022]
Abstract
This case is a 15-year-old male, presenting with headaches, right face, and arm numbness, and ataxia. MRI (magnetic resonance imaging) revealed a large right sided dumbbell shaped lesion, extending into the middle and posterior fossa with compression of the brainstem consistent with a trigeminal schwannoma. Treatment options here would be a retrosigmoid suprameatal approach or a lateral presigmoid approach. Given the tumor extension into multiple compartments, a presigmoid craniotomy, combining a middle fossa approach with anterior petrosectomy, and retrolabyrinthine approach with posterior petrosectomy were used to maximize the direct access corridor for resection. The petrous apex was already expanded and remodeled by the tumor. Nerve fascicles preservation technique is paramount to the functional preservation of the trigeminal nerve. The extent of resection should be weighed against the anatomical functional integrity of the nerve. Near total resection is considered if that means more nerve preservation. Postoperatively, the patient had a slight (House–Brackman grade II) facial droop, which resolved over days and developed right trigeminal hypesthesia at several weeks. This case is presented to demonstrate a combined petrosectomy technique for resection of lesions extending into both the middle and posterior cranial fossa with near total resection and trigeminal nerve preservation.The link to the video can be found at: https://youtu.be/kA9GyFhL1dg.
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Affiliation(s)
- Katherine Kunigelis
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, United States
| | - Daniel Craig
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, United States
| | - Alexander Yang
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, United States
| | - Samuel Gubbels
- Department of Otolaryngology, University of Colorado Hospital, Aurora, Colorado, United States
| | - A. Youssef
- Department of Neurosurgery, University of Colorado Hospital, Aurora, Colorado, United States
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Fares K, Abd-El-Hamid H, Youssef A, Rafla M. Statin-induced myopathy in muscles of lower limb with special reference to gastrocnemius muscle in albino rats. QJM 2018; 111. [DOI: 10.1093/qjmed/hcy200.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
- K Fares
- From the Human Anatomy and Embryology Department, Faculty of Medicine, Ain Shams University
| | - H Abd-El-Hamid
- From the Human Anatomy and Embryology Department, Faculty of Medicine, Ain Shams University
| | - A Youssef
- From the Human Anatomy and Embryology Department, Faculty of Medicine, Ain Shams University
| | - M Rafla
- From the Human Anatomy and Embryology Department, Faculty of Medicine, Ain Shams University
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Elnashar I, Farghaly T, Abdelmagied A, Youssef A, Badran E, Alkhwanky S, Elhamshary M, Abdelmagied A, Khamiss O, Al-Hussaini T. The effect of follicular fluid trace elements concentrations on intracytoplasmic sperm injection outcomes. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mabrouk M, Raimondo D, Del Forno S, Baruffini F, Arena A, Benfenati A, Youssef A, Martelli V, Seracchioli R. Pelvic floor muscle assessment on three- and four-dimensional transperineal ultrasound in women with ovarian endometriosis with or without retroperitoneal infiltration: a step towards complete functional assessment. Ultrasound Obstet Gynecol 2018; 52:265-268. [PMID: 29024196 DOI: 10.1002/uog.18924] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 09/06/2017] [Accepted: 09/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Previous studies comparing women with deep infiltrating endometriosis (DIE) and healthy controls have underlined an association between pelvic floor muscle (PFM) hypertonic dysfunction and deep lesions. The aim of this study was to compare the morphometry of PFM in women affected by ovarian endometriosis with DIE vs those without DIE in order to assess the impact of retroperitoneal infiltration by the disease on PFM function. METHODS This was a prospective study conducted between March 2015 and December 2016 on symptomatic women with a clinical and sonographic diagnosis of ovarian endometriosis with or without DIE, scheduled for laparoscopic surgery. We excluded patients with current or previous pregnancy, previous surgery for deep endometriosis, other causes of chronic pelvic pain or congenital or acquired abnormalities of pelvic floor anatomy. Three- and four-dimensional transperineal ultrasound was performed to evaluate PFM morphometry and assess levator hiatal area (LHA) and diameters at rest, during PFM contraction and during Valsalva maneuver. All volumes were analyzed offline by an investigator blinded to the clinical data. RESULTS One hundred and fourteen patients with ovarian endometriosis were enrolled in the study, 75 with DIE and 39 without DIE. The diagnosis of endometriosis was confirmed by histological examination in all patients. Compared with women without DIE, women with DIE showed a smaller LHA at rest, during contraction and during Valsalva maneuver (P = 0.03, P = 0.03 and P = 0.02, respectively) and a smaller reduction in LHA during PFM contraction (P = 0.04). CONCLUSIONS Women with ovarian endometriosis who were affected by DIE showed smaller hiatal dimensions than did women without DIE. Considering that PFM dysfunction in patients with DIE could cause pain symptoms and pelvic organ dysfunction, transperineal ultrasound could allow a more complete functional assessment and tailored therapy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Mabrouk
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - D Raimondo
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - S Del Forno
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - F Baruffini
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - A Arena
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - A Benfenati
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - A Youssef
- Obstetrics and Feto-Maternal Medicine, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - V Martelli
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - R Seracchioli
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
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Davies S, George A, Macallister A, Barton H, Youssef A, Boyle L, Sequeiros I. “It's all in the history”: A service evaluation of the quality of radiological requests in acute imaging. Radiography (Lond) 2018; 24:252-256. [DOI: 10.1016/j.radi.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/11/2018] [Accepted: 03/18/2018] [Indexed: 10/17/2022]
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